Day et al. Harm Reduction Journal (2018) 15:1 DOI 10.1186/s12954-017-0205-7 RESEARCH Open Access Music festival attendees’ illicit drug use, knowledge and practices regarding drug content and purity: a cross-sectional survey Niamh Day2,4†, Joshua Criss2,4†, Benjamin Griffiths 2,4†, Shireen Kaur Gujral 2,4†, Franklin John-Leader1, Jennifer Johnston3,4 and Sabrina Pit2,3,4* Abstract Background: Drug checking is a harm reduction strategy which allows users to check the content and purity of illicit drugs. Although drug checking has been trialled internationally, with demonstrated value as a harm reduction and health promotion strategy, the use of such services in Australia remains a contentious issue. This study aimed to investigate the proportion and patterns of illicit drug use among young people, their attitudes towards drug checking at festivals and the potential impact of drug checking on intended drug use behaviour. Methods: The survey was conducted at a major Australian music festival in 2016. Data was collected from a sample of festival attendees (n = 642) aged between 18 and 30 years. A descriptive analysis of the data was performed. Results: Nearly three-quarters (73.4%) of participants reported that they had used illicit drugs in the past 12 months, most commonly cannabis (63.9%) and ecstasy (59.8%). A large proportion of participants believed ‘somewhat’ or ‘alot’ that drug checking services could help users seek help to reduce harm (86.5%) and that drug checking services should be combined with harm reduction advice (84.9%). However, two thirds of the participants agreed ‘somewhat’ or ‘alot’ that drug sellers may use this service as a quality control mechanism (68.6%). Approximately half (54.4%) indicated they would be highly likely and a third (32.7%) would be somewhat likely to utilise free drug checking services should they be available at music festivals. When asked whether the results of drug checking would influence their drug use behaviour, participants reported that they would not take substances shown to contain methamphetamine (65.1%), ketamine (57.5%) or para-methoxyamphetamine (PMA) (58.4%). Conclusion: The majority of festival attendees aged 18–30 participating in this study reported a history of illicit drug use and were in favour of the provision of free drug checking at festivals. A considerable proportion reported that the results of drug checking would influence their drug use behaviour. The findings of this study can contribute to the debate regarding whether drug checking services could potentially play a major role in harm reduction and health promotion programming for young people attending festivals. Background 20–29 years age group, of which 28.2% reported use in In the most recent National Drug Strategy Household the last 12 months [1]. Survey (NDSHS) in 2016, almost 8.5 million (42.6%) Internationally, music festival attendees report particu- Australians aged 14 years and over reported use of illicit larly high levels of illicit drug use compared with the drugs in their lifetime, with 3.1 million (15.6%) reporting general population [2–4]. Consistent with this, studies use in the last month [1]. Prevalence was highest in the undertaken at festivals across Australia reflect a consid- erably higher rate of illicit drug use than is seen in * Correspondence: [email protected] same-age groups in the general population. A cross- †Equal contributors sectional study of 1365 adolescents, conducted at a 2School of Medicine, University of Western Sydney, Sydney, NSW, Australia music festival in Australia in 2011, found 52% had used 3School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia illicit drugs at least once, with 25% doing so in the previ- Full list of author information is available at the end of the article ous month [5]. Another study conducted from 2005 to © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Day et al. Harm Reduction Journal (2018) 15:1 Page 2 of 8 2008 in Australia demonstrated that 44% of music festi- laboratory-grade testing, as used in the CheckIt program val attendees had used illicit drugs in the last month [6]. in Austria [17], provides more accurate and detailed ana- Risks associated with the use of illicit drugs such as lyses for consumers about a wider range of substances. methylenedioxymethamphetamine (MDMA (3,4-methy- There is also the perception that drug checking could lenedioxymethamphetamine) or ecstasy) include adverse act as a quality control mechanism for drug dealers [22]. side effects such as hyperthermia, seizures, hyponatrae- mia, rhabdomyolysis and multi-organ failure causing Community perceptions death [7]. In addition, the inclusion of other substances Research commissioned by the Australian National in illicit drugs may also cause significant harm, both Council on Drugs found that more than 82% of a sample through an unexpected increase in purity resulting in of 2335 Australians aged between 16 and 25 years were overdoses and through the undesired inclusion of addi- in favour of the introduction of drug checking [23]. tives such as paramethoxyamphetamine (PMA), buty- Despite public support and backing from numerous lone and methylone [8, 9]. prominent political and law enforcement figures [24, 25], Due to the considerable discrepancy between the legislation for drug checking at festivals has yet to be prevalence of drug use in populations of festival goers passed by any state government in Australia. The main and the general population, it can be theorised that festi- arguments against drug checking are that there is a lack of val goers are more vulnerable to these harmful outcomes evidence to support its efficacy and that it may appear that and are therefore an important group to be targeted for the government is condoning drug use [26]. However, a harm reduction and education. motion in August 2016 passed unopposed through the Australian Senate calling for the introduction of evidence- Harm reduction based harm reduction policies to counteract harmful drug Several organisations in the USA and Europe offer an- use, including the cessation of sniffer dog use at festivals onymous drug checking services to the public [10]. and implementation of drug checking trials [25]. Countries such as France and Spain, which have a com- This study aims to increase our understanding of atti- parable legal stance on drug use to Australia, have active tudes and behaviours towards drug checking services drug checking services available as a harm reduction among music festival patrons. To our knowledge, this is intervention by communities and local governments [11, the first study based at a music festival to survey at- 12]. On-site drug checking interventions are already in tendees about drug checking services in Australia and place in the Netherlands and Austria [13]. Dutch citizens will provide valuable knowledge that will contribute to have been able to test their illicit drugs at government- the ongoing debate surrounding drug testing. funded Drug Information and Monitoring System (DIMS) facilities since the 1990s, for the purposes of harm reduction and prevention [14]. Utilisation of these Methods services has been demonstrated to influence user behav- Survey development and outcome measures iour [15]. The Trans European Drug Information (TEDI) The survey content and structure was guided by previ- program saw drug checking being offered at a number ous research in the area [1, 13, 27] and members of the of festivals across Europe, helping to profile the global research team with expertise in the fields of drug and al- drug market and creating a number of harm reduction cohol, sexual health, health promotion and public health. avenues that are aligned with drug checking [16]. Sub- All survey respondents were asked about their demo- stance education, psychosocial counselling and referral graphics, illicit drug use and attitudes towards drug options can be offered to an at-risk population while checking services. Those who indicated a history of illicit drug analysis is being performed [17]. Drug checking drug use were further questioned about their attitudes has led to an awareness of circulating harmful sub- and concerns towards drug content and purity, attempts stances, which has resulted in a decline of these prod- to find out about the content and purity of drugs they ucts on the market in subsequent years [2, 18, 19]. It had previously taken and the likelihood of using a free may also allow for the implementation of early warning drug checking service. systems to inform drug users of dangerous substances The data collected was predominately quantitative, before additional harm can result [2, 16]. with the exception of one open-ended question asking However, some concerns exist regarding drug check- drug users why they had never attempted to find out ing being perceived as encouraging drug use and the about the content/purity of their drugs (if applicable). limitations of accurate substance detection of reagent Two waves of pilot-testing of the survey were conducted testing kits [20]. These kits are limited in the number of with groups of young adults (n = 10 and n = 12, respect- substances they can identify, are operator-dependent ively) who were representative of the target audience, and do not identify non-drug components [21]. On-site with the data collection tool refined after each wave.